What are the key findings of this study?

April 13, 2021Seminars in Neurology

Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease

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Key result

Journal masthead contains no clinical trial data.

Why the study?

Stroke risk is high in cardiovascular disease, and because different cardiovascular conditions contribute to stroke via distinct mechanisms, optimal antithrombotic treatment varies and remains under active investigation.

Does antithrombotic therapy prevent ischemic stroke in patients with various types of cardiovascular disease?

Structured PICO

Does antithrombotic therapy prevent ischemic stroke in patients with various types of cardiovascular disease?

Population

Patients with cardiovascular disease (including atrial fibrillation, prosthetic heart valves, aortic arch atherosclerosis, congestive heart failure, endocarditis, patent foramen ovale, left ventricular assist devices, and extracorporeal membrane oxygenation) at risk for ischemic stroke

Intervention

Antithrombotic therapies (oral antiplatelet medications, IV and parenteral anticoagulants)

This review summarizes the pathophysiological mechanisms and current evidence for antithrombotic therapy in preventing stroke across a broad spectrum of cardiovascular diseases.

Implication

No trial data provided; leaves open antithrombotic therapy's role in stroke prevention across cardiovascular diseases.

Abstract

Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explore the mechanism of stroke and evidence for antithrombotic therapy in the following conditions: atrial fibrillation, prosthetic heart values (mechanical and bioprosthetic), aortic arch atherosclerosis, congestive heart failure (CHF), endocarditis (infective and nonbacterial thrombotic endocarditis), patent foramen ovale (PFO), left ventricular assist devices (LVAD), and extracorporeal membrane oxygenation (ECMO). While robust data exist for antithrombotic use in conditions such as atrial fibrillation, optimal treatment in many situations remains under active investigation.